Jana Mettwali

ENG210

Professor Zayas

Literature Review

April 2, 2025

Obsessive-Compulsive Disorder and the Fear of Contamination

Obsessive-Compulsive Disorder (OCD) is a long-term mental illness characterized by repeated, intrusive thoughts and compulsive acts, often carried out to alleviate the anxieties they provoke. Among the several forms of OCD, cleanliness OCD—with an emphasis on contamination phobia—is among the most prevalent and socially identifiable. Individuals suffering from this subtype are gripped by extreme fears of germs and filth and are driven to compulsively clean, wash their hands frequently, and avoid places.

This subject is particularly meriting study because OCD is often misunderstood and viewed as simply a quirk of personality, rather than as a legitimate mental disease. For people who live with cleanliness-based OCD, the disorder can impede everyday activities, isolate them socially, and degrade their quality of life. Discoveries about both the neurological and psychological components of this illness—and investigations into both established and advancing treatments—have the potential to demystify it and enhance the lives of those who live with it.

This review is divided into three sections: (1) the neurobiological underpinnings of cleanliness OCD, (2) psychological processes and coping strategies, and (3) treatments, both standard and novel therapies. The review integrates major studies that explore the way this type of OCD presents itself in the brain, how the fears of contamination are processed psychologically by the patient, and treatments that hold the most potential.

This literature review examines the neurological, psychological, and therapeutic aspects of cleanliness-based Obsessive-Compulsive Disorder to gain improved understanding of its causes, effects, and successful treatments.

Neurological Causes of OCD Regarding Cleanliness

Repeated research has demonstrated that there are hyperactive areas of the brain among those who experience OCD. Fineberg et al. (2013) indicate hyperactivity in the orbitofrontal cortex, anterior cingulate cortex, and striatum—all of these are involved in decision-making, emotion regulation, and repetitive behavior. This hyperactivity generates a cycle of feedback and does not allow the brain to effectively filter unwanted thoughts, and thus it causes compulsions, such as repeated washing or cleansing.

Again, Pauls et al. (2014) clarify that one of the neurotransmitters responsible for OCD is serotonin. When serotonin is depleted, the brain is unable to properly control anxiety and behavior. They attribute serotonin malfunction to abnormally activated fears, and this may account for the fact that those who have cleanliness OCD continue to perform their rituals despite knowing rationally that they are not needed.

A recent study by de Joode et al. (2023) utilized high-tech neuroimagiIing  to identify alterations in lateral occipital cortex metabolism when OCD symptoms were elicited. The results reflected abnormal neurochemistry, indicating that OCD involves not only structural but also metabolic aspects. These findings affirm the robust biological underpinnings of the disorder and pave the way for the investigation of brain-targeted treatments.

Psychological processes and emotion processing

Whereas the neurological infrastructure supplies the physiological explanation, the psychological aspect of OCD concerning cleanliness is just as significant. Based on Reuven, Liberman, and Dar (2014), compulsive cleansing rituals are frequently emotionally motivated reactions to feelings of guilt or moral distress. Their research was able to demonstrate that OCD individuals who performed cleansing rituals experienced temporary relief from feeling emotionally perturbed, reinforcing the compulsion.

This psychological connection between cleanliness and purity is important because it illustrates that OCD is not all about cleanliness—it’s also about regulation of inner states. This understanding accounts for the high efficacy of exposure therapy and cognitive-behavioral therapies because they target the irrational assumptions that drive compulsions.

Furthermore, Stephenson et al. (2021) examined electronically conducted CBT and made use of fMRI scans to monitor the activity of their patients’brains before and after treatment. Their results not only validated the psychological efficacy of CBT but also provided evidence of tangible alterations in brain function, closing the gap between mind and brain. The research adds strength to the case of CBT as both psychological and neurological treatment.

Treatment Approaches: Conventional and Novel The most frequently prescribed treatments are Cognitive Behavioural Therapy (CBT) and medications such as Selective Serotonin Reuptake Inhibitors (SSRIs). For Stein et al. (2019), CBT, and especially Exposure and Response Prevention (ERP), is the best psychological treatment, assisting the patient in resisting the urge to perform compulsions by gradually being confronted by feared situations. SSRIs, however, restore the balance of serotonin, diminishing the intensity and amount of intrusive thoughts.

Even though these treatments are available, many of these patients are treatment-resistant. New treatments, including Deep Brain Stimulation (DBS) and Transcranial Magnetic Stimulation (TMS), hold promise to help those who are severely affected. Although experimental, these treatments target brain areas directly responsible for OCD. According to Stein et al. (2019), these treatments were shown to effectively lower symptoms, particularly those who were not responsive to standard treatments.

Social perception is also involved in the way people experience and react to treatment. The media’s portrayal of OCD tends to oversimplify it as compulsive cleanliness and ignores the depth and diversity of the disorder. A recent article, Behind the Scenes: Unveiling the Misportrayal of Obsessive-Compulsive Disorder Depicted in Film and Television (2024), critiques those portrayals and their function as perpetrators of stigma. Proper awareness may enhance early diagnosis and encourage more individuals to seek treatments.

Cleanliness OCD is a complex disorder that is characterized by dysfunctional neurology, emotional processing, and learned behavioral habits. As there is ever-greater understanding of the brain areas and neurotransmitters implicated, psychological research keeps highlighting the underlying emotional drivers of the compulsions. CBT and SSRIs remain the established treatments, but newer therapies including DBS and TMS are breaking the mold for those who are looking beyond.

At the same time, combating societal misconceptions and stigma is equally as important as developing clinical treatments. In continuing to study both the biological and psychological aspects of cleanliness-OCD, we can work toward more empathetic care, more successful treatments, and improved lives for those afflicted by this frequently misunderstood disorder.

References

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. 

The Lancet, 374(9688), 491–499.

https://doi.org/10.1016/S0140-6736(09)60240-3

Behind the Scenes: Unveiling the Misportrayal of Obsessive-Compulsive Disorder in Film and Television. (2024). 

International Journal for Multidisciplinary Research, 6(5). https://doi.org/10.36948/ijfmr.2024.v06i05.29274

de Joode, N., van den Heuvel, O., Koster, M., Clarke, W., van Balkom, A., Schrantee, A., & Vriend, C. (2023). The Effect of OCD-Symptom Provocation on Neurometabolites in the Lateral Occipital Cortex and Their Relation to the BOLD Response, a Combined fMRS and fMRI Paradigm. 

Biological Psychiatry, 93(9), S242–S243.

https://doi.org/10.1016/j.biopsych.2023.02.608

Fineberg, N. A., Reghunandanan, S., Brown, A., & Pampaloni, I. (2013). Obsessive-compulsive disorder: 

The role of neuroimaging in diagnosis and treatment. Neuroscience & Biobehavioral Reviews, 37(10), 2256–2272. 

https://doi.org/10.1016/j.neubiorev.2013.02.014

Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: An integrative genetic and neurobiological perspective.

 Nature Reviews Neuroscience, 15(6), 410–424.

https://doi.org/10.1038/nrn3746

Reuven, O., Liberman, N., & Dar, R. (2014). The Effect of Physical Cleaning on Threatened Morality in Individuals With Obsessive-Compulsive Disorder. 

Clinical Psychological Science, 2(2), 224–229.

https://doi.org/10.1177/2167702613485565

Stephenson, C., Malakouti, N., Nashed, J. Y., Salomons, T., Cook, D. J., Milev, R., & Alavi, N. (2021). Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study. JMIR Research Protocols, 10(9), e30726. https://doi.org/10.2196/30726

Stein, D. J., Costa, D. L. C., Lochner, C., et al. (2019). Obsessive–compulsive disorder. Nature Reviews Disease Primers, 5(1), Article 52. https://doi.org/10.1038/s41572-019-0102-3